Scott: Against Medicaid expansion before he was for it - Bondi's not buying it - 2016 watch: Where the govs stand on Obamacare - McDonnell talking Medicaid, too - Report: Cool it on CT scans

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GOV. RICK SCOTT: AGAINST MEDICAID EXPANSION BEFORE HE WAS FOR IT — The Florida Republican pulled the ultimate 180 Wednesday, announcing support for a major expansion of his state’s Medicaid program, funded largely through President Barack Obama’s health care law. If the legislature goes along, it would throw open the doors of the program to an estimated 1.2 million low-income Floridians. It’s a remarkable shift for a governor who staked his name on derailing the health law before running for office on a platform of opposition. His state led the lawsuit that nearly toppled Obamacare in the Supreme Court. And it’s hard to ignore the reversal in tone:

July 2012: “Florida will opt out of spending approximately $1.9 billion more taxpayer dollars required to implement a massive entitlement expansion of the Medicaid program.” http://bit.ly/N47jwG.

Feb. 20, 2013: “While the federal government is committed to pay 100 percent of the cost of new people in Medicaid, I cannot, in good conscience, deny the uninsured access to care.” http://bit.ly/135jd6l

— Scott credited the turnabout to “new perspective” he gained after his mother’s death on Nov. 13. But his rhetorical shift, at least, also came days after Obama won reelection. On Nov. 16, Scott began talking about finding “common ground” with the White House on implementation. But he still took pains to cast the expansion as expensive and unaffordable (http://bit.ly/X9aw5j). Scott insinuated earlier this month that he’d back Medicaid expansion if the White House signed off on a pair of Medicaid waivers that granted Florida officials more authority to move Medicaid patients into managed care. The approval of the second waiver came just hours before Scott’s announcement. Scott’s prepared remarks: http://bit.ly/XlHRfk. The Pro story: http://politi.co/WXj2XB

BONDI’S NOT BUYING IT — Florida Attorney General Pam Bondi, who spearheaded the lawsuit against the health law, said she’s “concerned” about Scott’s decision to expand Medicaid. "[N]onetheless, at least Florida's lawsuit has given each state a choice,” Bondi said in a statement.

Happy Thursday and welcome to PULSE, where we’re still floored by the Florida expansion news. Pro-Obamacare Families USA called it a “hallelujah moment.” The National Women’s Law Center called it a “sensible approach.” But the White House is probably thinking a little more along the lines of Joe Biden, circa March 23, 2010: http://nbcnews.to/135unbj.

“Country roads, take me home to the PULSE I belong.”

TODAY ON POLITICO PRO:

— REPORT: COOL IT ON THE CT SCANS — Recommendations released this morning by leading medical groups pinpointed dozens of tests doctors should lay off to help reduce waste in the health care system: http://politico.pro/11WTYnB

— DRUG OVERDOSE DEATHS BREAK ANOTHER ANNUAL RECORD — Drug overdose deaths surged to a record high in 2010, according to a CDC analysis published yesterday in the Journal of the American Medical Association: http://politico.pro/W4l3CE

2016 WATCH: WHERE THE GOVS STAND ON OBAMACARE — Governors abound on the list of prospective GOP presidential contenders in 2016, and for those keeping score, they’ve split over Obamacare. Pro’s David Nather and Jason Millman take a microscope to the way these up-and-comers have addressed the health law, and a few themes emerged. Southern governors — Bobby Jindal, Nikki Haley, Bob McDonnell and Rick Perry — make up the “hell no” contingent, while more pragmatic governors — John Kasich, Chris Christie and Susana Martinez — are scattered. “It’s an intra-party struggle that mirrors the same fight that’s engulfed the Republican Party since Election Day, pitting anti-Obama hardliners against those concerned with appealing to a broader swath of voters,” the duo reports. http://politi.co/YcOnDq

McDONNELL TALKING MEDICAID, TOO — Virginia Gov. Bob McDonnell sent a letter to state lawmakers Wednesday reiterating his position against Medicaid expansion. “Please understand that I cannot and will not support consideration of an expansion of Medicaid in Virginia until major reforms are authorized and completed, and until we receive guarantees that the federal government's promises to the states can be kept without increasing the immoral national debt,” he wrote. “To do so would be irresponsible and place crushing financial burdens on future governors and legislatures. The country is broke, and I will not support policies that make it worse.” The letter: http://1.usa.gov/11VYu5D

INSURERS STRIKE BACK ON MEDICARE ADVANTAGE — America’s Health Insurance Plans is hitting back at the Obama administration Wednesday with a report suggesting that “millions of low-income and minority” Medicare beneficiaries rely on Medicare Advantage, the network of private plans offered to seniors. The administration recently proposed a 2.2 percent cut to Medicare Advantage plans beginning in 2014. About 28 percent of the nation’s Medicare beneficiaries opt into Medicare Advantage, according to the report, but that figure rises for African American seniors (31 percent) and Hispanic seniors (38 percent). In addition, 41 percent of Medicare Advantage beneficiaries had incomes of $20,000 or less. AHIP is warning that the cuts are piled on top of existing cuts enacted in the Affordable Care Act and a health insurance tax also due to take effect next year. “Washington cannot tax and cut Medicare Advantage this much and not expect seniors to be harmed,” AHIP CEO Karen Ignagni said in a statement. The report: http://bit.ly/WXHurF

REPORT: COOL IT ON THE CT SCANS — Recommendations released this morning by leading medical groups pinpointed dozens of tests doctors should lay off to help reduce waste in the health care system. “The leading medical associations, building on a batch of similar recommendations last year, said doctors should think twice in certain circumstances before conducting tests like CT scans or Pap smears, or inducing labor, according to recommendations released Thursday by the ABIM Foundation,” Pro’s Paige Winfield Cunningham reports. http://politico.pro/11WTYnA

ENGAGED: CMS communications chief Brian Cook said “yes” to his boyfriend Aaron this week after a romantic dinner at the restaurant where they had their first date four years ago. Aaron proposed with a ring Brian had won years earlier from a gumball machine and gave to Aaron as a gift. The proposal took place in the specially decorated foyer of the couple’s home. (h/t Lester Feder)

**A message from Healthcare Education Project: What if there aren't enough doctors? What if families lose access to care in their community? Deficit reduction talks are putting Americans' healthcare at risk with billions of proposed Medicare cuts to physician training and hospital clinics. It's time to protect America's healthcare. http://www.healthcareeducationproject.org/ **

ADMINISTRATION WEIGHS IN ON KIDS’ DENTAL – Remember all those problems with the pediatric dental benefits we told you about last week? The administration addressed one of them in Wednesday’s EHB rule. Now, major medical plans outside the exchanges can get a waiver from offering the pediatric dental benefit, paving the way for stand-alone dental plans to fulfill that need. The administration had already announced that strategy for plans inside the exchanges; this announcement extends the policy to plans offered outside the exchanges. Otherwise, some families might have had to pay for dental coverage twice: once, for the pediatric dental benefit in their health insurance plan, and again if the parents bought a separate plan to cover adult dental care. The Pro story: http://politi.co/XCS5nD

DRUG OVERDOSE DEATHS BREAK ANOTHER ANNUAL RECORD – Drug overdose deaths surged to a record high in 2010, according to a CDC analysis published Wednesday in the Journal of the American Medical Association, the 11th straight annual increase. Pro’s Brett Norman reports that the number of overdose deaths in 2010 (38,300) eclipsed traffic crash fatalities (32,800). Opioids like oxycodone were responsible for just under half of all overdose deaths. http://politico.pro/W4l3CE

SEQUESTER WATCH IS COMING – Keep an eye on your inboxes for “Sequester Watch,” a Pro-only newsletter to keep readers in the loop on the lead-up to March 1 — or later, if the sequester deadline gets extended. POLITICO’s Jon Allen will deliver Sequester Watch weekdays at or about 8 a.m.

ACP LISTS POLICY GOALS — The American College of Physicians, in its annual report on the state of health care, is calling for effective implementation of the health law, elimination of the sequester, repeal of the Sustainable Growth Rate, a primary care recruitment program and at least two initiatives to reduce gun deaths: background checks for all gun sales and a ban on high-capacity magazines. The report: http://bit.ly/YbkH9B

YOHO FLEXES ANIMAL INSTINCTS ON OBAMACARE – Rep. Ted Yoho, a veterinarian who ousted a veteran Florida Republican in November by attacking him from the right, took a swipe at Obamacare in, er, clinical terms on Tuesday night. Yoho pledged during a town hall meeting in Lake City to “neuter it and take the bark out” of the health care law, according to the Lake City Reporter. http://bit.ly/VvJiHz

PRO TRIVIA IS BACK – Hosted by Pro’s Tony Romm and POLITICO’s Juana Summers, questions run the gamut of policy, politics and all things DC. Trivia night is scheduled for Tuesday, Feb. 26 at 6 p.m. RSVP with teams of four to eholman@POLITICO.com.

ALLIANCE ADDS LANSKY TO BOARD OF DIRECTORS – The Alliance for Health Reform tapped David Lansky, CEO of the Pacific Business Group on Health, as the newest member of its board of directors. The nonpartisan nonprofit’s mission is to help educate elected officials and reporters on health policy issues.

WHAT WE’RE READING, by Brett Norman

Time magazine’s Steven Brill writes a 36-page cover story, a seven month investigation, exploring the “bitter pill” of the American health care system lavishing massive profits on industry stakeholders in part because of nearly arbitrary — and arbitrarily humongous — prices for care. http://ti.me/15wrtfm

An op-ed in The Wall Street Journal looks at how the Republican Medicaid expansion “flippers” — like Florida Gov. Rick Scott — are justifying their flips, and how the media is focusing on the politics instead of policy. http://on.wsj.com/XNMA5J

The Tampa Bay Times examines Gov. Scott’s endorsement of Medicaid expansion in light of the controversy — plagued underlying managed care demonstration program that the expansion will be based on … with the blessing of HHS waivers. http://bit.ly/135jd6l

Conservative policy gurus Douglas Holtz-Eakin and Avik Roy argue in Reuters that Obamacare is here to stay, and the best strategy for conservatives is to reform it in the direction of free markets. http://reut.rs/YzJQuu

The CBO’s projection for Medicare spending has fallen by more than $500 billion since 2010, the Center on Budget and Policy Priorities notes. http://bit.ly/13b1iXG

The ACLU is seeking people who have been denied reproductive care or end-of-life services by religiously oriented health care providers. http://bit.ly/WSYEoJ

The Washington Post’s Sarah Kliff flags a clarification in the essential health benefits rules that says patients who have a polyp removed while they are getting a colonoscopy won’t wake up and have to pay an unsuspected bill, because it’s still a preventive procedure. http://wapo.st/15vHL8o

**A message from Healthcare Education Project: Deficit reduction talks are putting everyone's healthcare at risk with drastic proposed Medicare cuts to graduate medical education and hospital outpatient payments. America is already facing a physician shortage, with a third of all doctors set to retire in the next decade and an aging population straining healthcare services. In many urban and rural communities, hospital outpatient clinics are the only source for healthcare. The billions of dollars in proposed cuts to these clinics ignores the added costs hospitals incur for caring for the uninsured and underinsured, and will force closures across the country. Fixing our deficit by accelerating our doctor shortage and cutting care for patients isn't the answer. Protect access. Protect your care. http://www.healthcareeducationproject.org/ **

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